Hospital of the future: ending the patient gridlock

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Hospitals are enduring a fundamental crisis. Today’s hospitals face a perfect storm of rising costs, falling productivity and eroding patient trust. These are not signs of failure but of an outdated model – as such, the future of the NHS depends on reinventing the hospital itself. This is the founding premise of the ‘Hospital of the Future’ programme. 

Ending the Patient Gridlock is the third paper in this series. It seeks to open up the black box of hospitals to examine exactly what is preventing patients from moving in, out and through hospitals efficiently – otherwise known as patient flow.  

Too often, the experience of patients in hospitals is mired by waiting, uncertainty and a sense of being passed from queue to queue. This is not only unpleasant but inefficient: in February 2025, at the height of the winter crisis, there were on average 13,740 patients stuck in hospital despite being medically fit to leave. This is equivalent to nearly 23 hospitals’ worth of inpatients who no longer needed to be in hospital.  

Flow has become the Achille’s heel of modern hospitals – internal and external bottlenecks, as well as a manifest failure to align capacity with demand, means that patients end up in hospital longer than is good for them, the system and the taxpayer. 

Getting patient flow right is one of the NHS’s greatest untapped opportunities. It can expand capacity without new money or beds, improve quality and safety, and creates the foundation for an efficient, productive hospital. In a system under constant pressure, optimising flow is no longer optional but essential. We could manage it as rigorously as a factory line, but we don’t.  

It is, therefore, an essential cornerstone of the hospital of the future. To move towards this model, this paper proposes 25 recommendations, including:  

1. A new clinical specialty – the hospitalist
   
   This model, long established in the United States, trains doctors to take charge of whole wards of patients whose conditions cut across multiple specialties. These are the complex, multimorbid cases that fall between the cracks of traditional hospital medicine, who make up an increasingly large portion of demand. With a hospitalist, patients could receive a clear, coordinated clinical decision from a single doctor within hours, rather than wait days for four different specialists to weigh in.   
2. A seven-day discharge workforce
   
   The mismatch between seven-day admissions and five-day discharges haunts the NHS – weekend discharges are 40 per cent lower than on weekdays, creating a constant logjam at the back door of the hospital. This does not mean making the entire workforce work on the weekends: just those essential to discharge. This includes pharmacists, occupational therapists, social workers, as well as empowering more nurses to make decisions to discharge.   
3. More and better operational managers
   
   Despite their frequent criticism, managers are essential to the operational efficacy of a hospital. But we don’t have enough and they’re not trained properly. We propose creating a professional body, similar to the General Medical Council, for NHS management, alongside a professional accreditation.